Ambulance crews get to decide on destination

Dr. Elizabeth McLaughlin is the HSA coordinator for accident and emergency care and a doctor of emergency medicine. - Photo: Mark Muckenfuss

Heidi Presser, 42, was ready to board a plane at Owen Roberts International Airport recently, when she began having trouble breathing and felt pressure in her chest.

An ambulance was called and by the time emergency medical technicians loaded her for transport, Ms. Presser said she could not move her arms or her legs. The EMTs told her they were taking her to Cayman Islands Hospital.

Ms. Presser lives in Connecticut, but has family on the island. She told the emergency crew she wanted to be taken to Health City in East End instead.

“The ambulance driver said George Town was closer,” Ms. Presser said.

That is where she ended up, although her family later took her to Health City, where she was diagnosed with an asthma attack brought on by bronchitis.

Ms. Presser’s experience is one example of questions that are sometimes raised about how much control patients have over which hospital they are taken to in an emergency, and what goes into the decision by EMTs in making that determination.

With Health City planning to expand its emergency services and reintroducing its own ambulance service, such decisions may become more complicated.

Dr. Elizabeth McLaughlin, accident and emergency coordinator for government’s Health Services Authority, said regardless of what changes may lie ahead, the basic precept will not change.

“Based on the assessed needs of the patient, they will be taken to the place that can best provide care,” Dr. McLaughlin said.

And the people making the ultimate decision about where that is are the EMTs, not the patient.

The Health Services Authority runs three ambulances on Grand Cayman. Health City plans to reintroduce its own ambulance in coming weeks. – Photo: Chris Court

“Their wishes will be taken into account, but it will not be the deciding factor,” Dr. McLaughlin said. “It’s always a balancing act. Where that patient ends up at the end of the day is complex.”

Dr. McLaughlin said the HSA, which operates Cayman Islands Hospital and the current ambulance system on the island, coordinates care with Health City. Some patients, particularly those with cardiac emergencies, are taken to Health City, where there are more resources for treating such cases.

“There are certain things that Health City does well, and I don’t have a problem with that,” Dr. McLaughlin said, adding that Cayman Islands Hospital is “the best at emergency management. You’re guaranteed pretty much a specialist in emergency medicine at all times.”

With plans to expand its emergency department to 10 beds, Health City officials said they plan to have an emergency specialist available 24 hours a day beginning in the fall. The hospital said it currently accepts international emergency cases from islands such as Anguilla and Turks and Caicos, which may not have the facilities to treat certain critical patients.

“We’re expanding this area with very modern facilities and personnel,” said Dr. Binoy Chattuparambil, clinical director and chief cardiac surgeon at Health City. “At the same time, we are not going to compete with Cayman Islands Hospital. There is no room for competition here. We all compliment each other.”

That cooperation may be challenged by Health City’s ambulance service. The single ambulance, which will be operated by a third party company, will be used to transport international patients from Owen Roberts International Airport and from cruise ships, with whom Health City contracts. But it will also be available for general emergency calls through a dedicated number. It will not be part of the 911 emergency system, at least for the near future.

Dr. McLaughlin sees potential problems with that.

“I think it should be tied into the 911 system,” she said, “and that does require a significant amount of logistics.”

Health City previously operated an ambulance under similar arrangements for a two-year period that ended this spring when the operator left Cayman. Dr. Chattuparambil said there were no conflicts with HSA during the time the ambulance was on the road.

“For two years it was working without any dispute,” he said.

Health City spokesman Shomari Scott said he knew of only one instance where the Health City ambulance and an HSA ambulance showed up at the same place. That happened, he said, when a port official accidentally called 911 for a cruise ship patient already being picked up by the Health City ambulance.

“That was maybe a one-off scenario,” Mr. Scott said, calling it an “anomaly.”

The Health City ambulance actually proved beneficial to HSA on some other occasions, he said.

“There have been a few situations where their ambulances were tied up and they needed a transfer and our ambulance could do it,” he said.

But Dr. McLaughlin said there were also conflicts.

“What we had before was people calling both ambulances to see who got there first,” she said.

Mr. Scott said it is likely Health City’s ambulance eventually will be tied into the 911 system. “They’ll probably reach that point sometime in the future,” he said.

He said the hospital’s ambulance and the expanded emergency services – which will include a triage operating room – will be a benefit for Cayman, particularly for those on the East End of the island who may be too critical for the half-hour drive to George Town. He’s confident his hospital and the HSA can coordinate such care.

“We definitely want to get better at working with the government on that so we can treat and stabilize as quickly as possible,” he said.

Officials at both hospitals said delivering quality care as quickly as possible is the bottom line. Having additional emergency services should help and allow for more options in patient care. Those patients can make their wishes known in an emergency, but they will not have the final say.

“If somebody wants to come here, they should come,” said Dr. Chattuparambil. “But the EMT has to make the decision as to what is good for the patient, and the EMTs are good at that.”